Nontraditional risk factors for cardiovascular disease in patients with chronic kidney disease

Patients with chronic kidney disease (CKD) have a reduced lifespan, and a substantial proportion of these individuals die from cardiovascular disease. Although a large percentage of patients with CKD have traditional cardiac risk factors such as diabetes, hypertension and abnormalities in cholesterol, interventions to address these factors--which have significantly decreased cardiovascular mortality in the general population--have not shown such benefit in the CKD population. In addition, the severity and extent of cardiovascular complications in patients with CKD is disproportionate to the number and severity of traditional risk factors. This realization has focused attention on nontraditional cardiac risk factors that are particularly relevant to patients with CKD, including decreased hemoglobin levels, microalbuminuria, increased inflammation and oxidative stress, and abnormalities in bone and mineral metabolism. However, large prospective trials in patients with advanced CKD or in those requiring chronic dialysis have not shown that normalization of these nontraditional risk factors improves survival. Moreover, the mechanisms by which these nontraditional risk factors contribute to cardiovascular disease are unknown. Therefore, although current treatment of patients with CKD includes management of traditional and nontraditional risk factors, the value of modifying some nontraditional risk factors remains unclear.     

老年慢性肾脏病患者生活质量评估及其危险因素分析

目的:了解65岁以上慢性肾脏病（chronic kidney disease,CKD）患者的老年综合评估评分情况,并分析患者生活质量的相关影响因素。方法:本研究为回顾性队列研究,入选2016年10月至2019年10月在山西省人民医院肾内科诊断为CKD且65岁以上的189例患者,依据患者是否透析分为透析组（ ...     

非透析慢性肾脏病患者高尿酸血症的危险因素分析

目的 探讨和分析非透析慢性肾脏病(non-dialysis chronic kidney disease,ND-CKD)患者高尿酸血症(hyperuricemia,HUA)的发生率及其相关危险因素.方法 收集2015年1月至2019年12月于山西医科大学第二医院肾内科就诊的540例ND-CKD患者的临床资料,依据HUA...     

Risk factors for increased left ventricular hypertrophy in patients with chronic kidney disease

Background

Although left ventricular hypertrophy (LVH) has been established as a predictor of cardiovascular events in chronic kidney disease (CKD), the relationship between the prevalence of LVH and CKD stage during the predialysis period has not been fully examined.

Methods

We measured left ventricular mass index (LVMI) in a cross-sectional cohort of participants in the Chronic Kidney Disease Japan Cohort (CKD-JAC) study in order to identify factors that are associated with increased LVMI in patients with stage 3–5 CKD. LVH was defined as LVMI > 125 g/m² in male patients and >110 g/m² in female patients.

Results

We analyzed baseline characteristics in 1185 participants (male 63.7 %, female 36.3 %). Diabetes mellitus was the underlying disease in 41.3 % of patients, and mean age was 61.8 ± 11.1 years. LVH was detected in 21.7 % of patients at baseline. By multivariate logistic analysis, independent risk factors for LVH were past history of cardiovascular disease (odds ratio [OR] 0.574; 95 % confidence interval [CI] 0.360–0.916; P = 0.020), systolic blood pressure (OR 1.179; 95 % CI 1.021–1.360; P = 0.025), body mass index (OR 1.135; 95 % CI 1.074–1.200; P < 0.001), and serum calcium level (OR 0.589; 95 % CI 0.396–0.876; P = 0.009).

Conclusion

Cross-sectional baseline data from the CKD-JAC study shed light on the association between LVH and risk factors in patients with decreased renal function. Further longitudinal analyses of the CKD-JAC cohort are needed to evaluate the prognostic value of LVH in CKD patients.     

Comorbidity and cardiovascular risk factors in patients with chronic kidney disease

The mortality rate among dialysis patients is high. Although guidelines have been in place to improve outcomes in dialysis patients, new emphasis is being placed on better management of patients who are pre-end-stage renal disease (pre-ESRD)-patients with chronic kidney disease (CKD). Spearheaded by the National Kidney Foundation, the National Institute of Health, and the nephrology community at large, an effort is underway to improve the care of patients with kidney disease. We hope that improvement in health and outcomes of patients with kidney disease will be optimized through attention to care before the development of advanced renal disease. Cardiovascular disease (CVD) is an important comorbidity of chronic kidney disease, and reducing cardiovascular events in this population is an important goal for the people who care for chronic kidney disease patients. In this article, we review the available literature regarding certain risk factors for cardiovascular disease: proteinuria, hyperglycemia, hypertension, homocysteine, hyperlipidemia, and inflammation. When possible, recommendations for treatment are provided based on the information reviewed.     

慢性肾脏病5期非透析患者动脉粥样硬化危险因素分析

目的 探讨慢性肾脏病5期非透析患者发生颈动脉粥样硬化的危险因素.方法 选择慢性肾脏病5期非透析患者54例和健康对照者31名检测血肌酐、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、脂蛋白α、白蛋白、血清钙、血清磷、C反应蛋白、晚期氧化蛋白产物等指标,并进行颈动脉超声检查颈动脉内膜中层厚度和粥样斑块.分析影响颈动脉内膜中层厚度的危险因素.结果 两组患者晚期氧化蛋白产物、C反应蛋白比较差异有统计学意义(P＜0.01),且慢性肾脏病5期非透析患者中颈动脉内膜中层厚度明显增厚且动脉斑块发生率高(P＜0.01);多元线性回归分析显示年龄、收缩期血压、血清磷、脂蛋白α、氧化蛋白产物、C反应蛋白是颈动脉内膜中层厚度增厚的独立危险因素.结论 氧化应激、微炎症反应及高血压、高血脂、高血磷等复杂因素的相互作用可能在慢性肾脏病5期非透析患者加速冠状动脉粥样硬化的发生、发展中起重要作用.     

慢性肾脏病5期非透析患者动脉粥样硬化危险因素分析

目的 探讨慢性肾脏病5期非透析患者发生颈动脉粥样硬化的危险因素.方法 选择慢性肾脏病5期非透析患者54例和健康对照者31名检测血肌酐、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、脂蛋白α、白蛋白、血清钙、血清磷、C反应蛋白、晚期氧化蛋白产物等指标,并进行颈动脉超声检查颈动脉内膜中层厚度和粥样斑块.分析影响颈动脉内膜中层厚度的危险因素.结果 两组患者晚期氧化蛋白产物、C反应蛋白比较差异有统计学意义(P＜0.01),且慢性肾脏病5期非透析患者中颈动脉内膜中层厚度明显增厚且动脉斑块发生率高(P＜0.01);多元线性回归分析显示年龄、收缩期血压、血清磷、脂蛋白α、氧化蛋白产物、C反应蛋白是颈动脉内膜中层厚度增厚的独立危险因素.结论 氧化应激、微炎症反应及高血压、高血脂、高血磷等复杂因素的相互作用可能在慢性肾脏病5期非透析患者加速冠状动脉粥样硬化的发生、发展中起重要作用.     

慢性肾脏病患者心血管疾病危险因素探讨

目的探讨慢性肾脏病（CKD）患者心血管疾病的危险因素。方法收集我院542例住院CKD患者的病史、实验室检查和辅助检查结果,将患者根据有无心血管疾病分为2组,根据Logistic回归分析结果探讨心血管疾病的危险因素。结果高龄、高血压、高尿酸血症、贫血、蛋白尿是CKD患者心血管疾病的危险因素;CKD1～5期患者心血管疾病的危险因素各不相同。结论CKD进展和CKD患者心血管疾病的发生拥有部分相同的危险因素;在CKD早期以传统危险因素为主,随着肾功能的恶化,非传统危险因素起主导的作用。     

Care of elderly patients with chronic kidney disease

Background Providing optimal care to the growing number of chronic kidney disease (CKD) patients remains a significant problem in the United States. There is little known about the care of elderly CKD patients by primary care physicians as well as nephrologists. Methods We performed a retrospective study of 377 elderly male CKD (serum creatinine >1.4 mg/dl on 2 separate occasions 3 months apart) patients referred to the Nephrology Clinic at the Buffalo Veterans Administration Medical Center between 1999 and 2002 to see if the pattern of care changed during this time. Results The mean age of the patients was 75.9 years. Eighty-four percent were Caucasian, 15% were African-American, and 1% were of other race. Etiology of CKD included hypertensive nephrosclerosis (49%), diabetic nephropathy (23%), renovascular disease (18%), and others (10%). Sixty-five percent of patients had estimated glomerular filtration rate (eGFR) >30 ml/min. Overall angiotensin converting enzyme inhibitor (ACEI) was used in 51% of patients with CKD, and in 63% of patients with diabetic nephropathy. Twenty percent of patients had a hemoglobin <11 g/dl, darbepoietin/epogen was used in 31% of these patients. Screening for kidney related tests were done infrequently while lipid profile and hemoglobin A1C were done in the majority of patients because of clinical reminders in the VA computerized patient record system (CPRS). Conclusion These results emphasize the need for increased education of primary care physicians and nephrologists to improve the care of elderly CKD patients. Although there was a trend towards earlier referral, care did not change significantly between years 1999 and 2002.     

Predictive cardiovascular risk factors in patients with chronic kidney disease (CKD)

BACKGROUND: Traditional cardiovascular risk factors and uremia-related specific factors have been identified in patients with CKD, explaining the highest risk for morbidity and mortality from cardiovascular disease. The aim of this study was to analyze the predictive power of several cardiovascular risk factors and markers in a population of stable patients with moderate CKD. METHODS: One hundred twenty-eight (78 M, 50 F) outpatients with estimated glomerular filtration rate (GFR) <60 mL/min were included in the study. Medical records about cardiovascular factors were recorded. Analytical parameters and cardiac markers were analyzed. The patients were prospectively followed, and the end points were fatal and nonfatal cardiovascular events. RESULTS: After a mean follow-up of 22.3 months, 27 patients had a cardiovascular event. The patients who suffered a cardiovascular event were older (P= 0.002), with more anemia (P= 0.014), higher pulse pressure (P= 0.011), and cTnT levels (P= 0.000). In addition, they had more prevalence of LVH (P= 0.001), diabetes (P= 0.013), previous coronary heart disease (P= 0.008), chronic heart failure (P= 0.000), vascular peripheral disease (P= 0.006), and had also a higher score of 10-year coronary heart disease predicted risk (P= 0.006). Age [hazard ratio (HR) 1.07, P= 0.02], previous coronary artery disease (HR 4.08, P= 0.0012), and cTnT levels (HR 1.64, P= 0.0000) independently predicted cardiovascular events on multivariate Cox analysis. CONCLUSION: In stable patients with CKD, age and previous coronary artery disease were the traditional cardiovascular risk factors more predictive for cardiovascular events. Cardiac troponin T is a powerful marker of cardiovascular events in CKD patients.     

Traditional cardiac risk factors in individuals with chronic kidney disease

Individuals with chronic kidney disease (CKD) are at increased risk for the development and progression of cardiovascular disease (CVD). The increased risk is due to a higher prevalence of both traditional risk factors as well as nontraditional risk factors. In this review we focus on individuals at all stages of CKD and discuss modifiable traditional risk factors, namely hypertension, dyslipidemia, diabetes mellitus and poor glycemic control, smoking, and physical inactivity. The prevalence of each risk factor and its relationship with CVD is described. Treatment recommendations are provided using evidence available from populations with CKD or evidence extrapolated from the general population when there are insufficient data on individuals with CKD.     

Prevalence and risk factors of chronic kidney disease in first-degree relatives of chronic kidney disease patients in Southern China

Aim: The aim of this study was to estimate the prevalence and risk factors of chronic kidney disease (CKD) in first‐degree relatives (FDRs) of CKD patients. Methods: A cross‐section study of first‐degree relatives of CKD patients was conducted between November 2007 and March 2009 in southern China. A total of 1187 first‐degree relatives (494 male and 693 female; mean age 41.26 years) of 419 CKD patients (194 male and 225 female; mean age 32.10 years) were reviewed and tested for haematuria, albuminuria and reduced glomerular filtration rate. CKD risk factors, including age, gender, body mass index, hypertension and the causes of index case were also investigated. CKD was diagnosed according to the criteria of the National Kidney Foundation‐Kidney Disease Outcomes Quality Initiative. Results: The prevalence of CKD in first‐degree relatives of CKD patients was 29.7% (95% confidence interval [CI]: 27.1%–32.2%). After adjusting for all the potential confounders, older age, female gender, hypertension, hyperglycaemia, hyperuricaemia, hypertriglyceridemic, low level of high density lipoproteins, increased body mass index and nephrotoxic medications were independently associated with increased risk of CKD. Furthermore, relatives of index cases with chronic glomerulonephritis were at higher risk haematuria (ORs = 2.12, 95% CI: 1.45–3.10) compared with relatives of index cases with other kinds of renal diseases. Conclusion: The first‐degree relatives of CKD patients are at high risk of CKD, especially those relatives of CKD patients with chronic glomerulonephritis. Screening in this high risk population might help to identify early CKD patients and make a proper intervention strategy to prevent the disease from quick progression.     

Fracture risk assessment in patients with chronic kidney disease

Fractures are common in patients with chronic kidney disease (CKD) and associated with substantially high morbidity and mortality. Bone mass measurements are commonly used to assess fracture risk in the general population, but the utility of these measurements in patients with CKD, and specifically among those on hemodialysis, is unclear. This review will outline the epidemiology and etiology of fractures in patients with CKD with a particular emphasis on men and women on hemodialysis. As well, we will summarize the published data, which describes the association between risk factors for fracture (including bone mass measurements, biochemical markers of mineral metabolism, and muscle strength) and fractures in patients with CKD. Patients with CKD suffer from fractures due to impairments in bone quantity, bone quality, and abnormalities of neuromuscular function. There is a paucity of evidence on the associations between bone quality, bone turnover markers, neuromuscular function, and fractures in patients with CKD. Furthermore, the complex etiology of fractures combined with the technical limitations of bone mineral density testing, both by dual energy X-ray absorptiometry (DXA) and by peripheral quantitative tomography (pQCT), limits the clinical utility of bone mass measurements for fracture prediction in CKD; this is particularly true among patients with stages 4 and 5 CKD. Further prospective studies to identify noninvasive measures of bone strength that can be used for fracture risk assessment are needed.